by Dr. Erin Carr, May 18, 2021
Have you experienced nagging popping, clicking or sharp pain every time you reach your arm over head? Developed frozen shoulder for no reason? Dislocated your shoulder from a fall or sports injury? Or were in a car accident. Depending on how you injured your shoulder and whether it is acute or chronic. How to heal shoulder pain requires an integrative approach.
It is important to note that the shoulder is one of the most complex joints in the body. It is not made up of a single joint, rather it consists of four! Shoulder pain healing, takes time. As the entire shoulder girdle must be addressed. The shoulder is the most mobile yet unstable joint in our body. As it is susceptible to gravitational pull while the arm hangs by our side naturally. It requires the support from the bony joints themselves as well as the soft tissue layers of ligaments, muscles, tendons and fascia. All of which connect the shoulder blade, collar bone, rib cage, neck and arm. Forming a “girdle.” When injured, a cascade of compensations may occur. Often in the form of muscle tightness, muscle guarding, nerve tension as well as possible arm, neck and upper back pain.
In order to heal shoulder pain, understanding how to treat the complexities of the multiple joints, muscles, tendons, ligaments, nerves and arteries involved is essential.
In this fourth blog post in our “Heal Chronic Pain” series. “Heal Shoulder Pain” is our focus. Dr. Carr Integrative Physical Therapy will provide an understanding of the main types of shoulder pain. How they manifest and come to understand how unassuming areas of our body may relate or contribute to healing your shoulder pain.
As mentioned in the previous blogs throughout this heal chronic pain series. Although normal soft tissue healing usually takes approximately 6 weeks. The actual rehabilitation of the shoulder often takes longer. It is easy to develop habits that hinder your healing. Do you find yourself shrugging your shoulder when you reach for something overhead? Or bend forward from the waste when reaching your arm back behind you to put a jacket on? Our body will adapt in order to accomplish an activity no matter how it is done.
It is also important to keep in mind. How easy it is to avoid using your injured shoulder. Especially when there is another functioning arm that can handle lifting, carrying and so many other activities requiring use of our upper body. Fear avoidance is a significant factor that leads to chronic injury or pain.
Whether there is muscular imbalance, nerve tension or fear of use. An integrative approach to heal shoulder pain is necessary. It will not only unravel incorrect movement patterns and restore function. You will learn to use your shoulder properly. Rehabilitate it with appropriate techniques to reduce pain. All while eliminating any fear associated with this injury to re-establish your confidence!
As mentioned above, the shoulder anatomy is complex. It consists of 4 joints, 3 ligaments, a labrum, 6 bursa and 19 muscles! The layers of larger muscle groups. Some of which include the bicep, pec, deltoid and tricep are often over worked. As the smaller deeper muscles known as the rotator cuff. Actually provide inherent joint stability along with the labrum and shoulder ligaments.
Of all the joints in the body, the shoulder allows for the most freedom of movement. From basic activities that require us to reach overhead, behind the back, across your body. To more complex multi dimension movements like a pitch, golf or tennis swing. Because of this range of motion, it is also more susceptible to injury.
Shoulder pain can manifest in many different ways. Symptoms can manifest in ways that cause shoulder pain. Although the source of that pain is coming from somewhere else in the body.
In general, referred pain occurs as various structures in the body are made of up of similar tissue. Or the nerve that supplies one area of your body also share branches of that same nerve root feeding another area of the body. For example, the C5-6 segment in your neck sends branches of its nerve root to the skin and muscles in and around the shoulder. Some of these are superficial muscles like the bicep. As well as deep muscles including all 4 rotator cuff muscles. This same nerve branch continues to travel down the arm into the elbow, wrist and fingers. And becomes what so many know as the “carpal tunnel” nerve. Therefore your pain, weakness or limitation in the shoulder could also have relation to your neck and structures down your arm and into your fingers.
Common Local Injuries
Injuries to structures in the shoulder girdle can result in tendonitis, tendonosis, instability, bursitis, or arthritis. All of which can cause stiffness, weakness, popping, clicking, clunking, and pain. Resulting in difficulty reaching overhead, behind your back, carrying or lifting something heavy or light. It can also infringe on your sleep, work and day to day life.
Unassuming Referred Pain
Have you ever wondered why your shoulder hurts even though you don’t recall injuring it? As mentioned earlier, the nervous system and fascia networks innervate various areas of our body. Therefore, the source of your pain may be coming from another region of your body yet manifests in your shoulder. Structures in the body that refer to the shoulder include the liver, gallbladder, lung or heart.
For example, If you have been rear ended and the seat belt locks up. It crosses your rib cage compressing the diaphragm and phrenic nerve. The nerve that feeds the diaphragm. When this occurs, it can also cause fascia restrictions around the liver, gallbladder or lung tissue. Reverberating referral into the shoulder girdle. If this fascia network of tissue is neglected during treatment, your shoulder pain may not resolve fully.
Whole Body Physical Therapy
What you can do
- Isometrics – stabilize through isolated movements to strengthen the rotator cuff. These not only support the shoulder girdle. They helps suction the ball joint into the socket.
- Scapular stability – Is one of the primary areas to address when building stability in the shoulder girdle. Aside from the rotator cuff. The serratus anterior, mid and lower trapezius are essential in restoring the health and function of your shoulder. Incorporate a push up plus, single or double arm row into your routine.
- Core strength – Is essential after you have had an injury to any area of your body including your shoulder. A weak core affects your posture, spine health and overall stability. When you reach overhead or lift something off of the floor. Your core is supposed to fire first. If it is not firing, your shoulder muscles and joints take more of the force. Planks are a great way to strengthen your core and shoulder girdle simultaneously.
- Weight bearing and crawling – Although crawling played short period in our motor development. It is one of the most important mile stones for brain development. Getting into a quadruped position. Going on hands and knees in a crawl position. Builds strength, endurance re-education of the entire shoulder girdle. It also helps build a better connection with our brain to know to send the proper signals to the nerves feeding our shoulder girdle.
- Thoracic mobility – The last 10 degrees of movement required to reach overhead. Comes from your thoracic spine. In order to heal shoulder pain. Improving the ability to extend your upper back through your rib cage will positively impact the health of your shoulder. Try gentle cobra press ups. Or lie on a foam roller to open your chest and relax tightness found in the back of your rib cage.
- Breath work – The rib cage and diaphragm play a big part in shoulder function. If you find yourself hunched over your computer breathing shallowly through your chest you are not accessing your diaphragm. The main muscle for breathing. Breathing slowly in and out through your nose can help you access the lower lobes of your lungs for improved oxygen exchange. This too helps with diaphragm expansion. Decreasing tension in your upper chest, shoulders and neck.
How We Can Help
Aside from incorporating appropriate exercises that create more balance, body awareness, stability and mobility to your shoulder girdle as well as supporting areas. In person integrative physical therapy techniques will aid in the healing of shoulder pain. Whether utilizing skilled kinesiotape techniques are needed to help reduce inflammation, re-educate the muscles or stabilize the joints. Incorporating gentle hands treatments to reduce pain, inflammation while restoring overall function. Understand that not all shoulder injuries or pain are receive identical treatments. Customized plans to address your specific needs are essential when you want to experience long lasting pain relief that does not come back.